Naturopathic quackery tries to insinuate itself in the VA

Our military veterans deserve the best medical care our nation can offer. Actually, I'd say they're owed it, actually. After all, many of them put themselves in harm's way for this country. Others have suffered grievous injury with permanent sequelae. Still others have paid the ultimate price. For those who served, the least we as a nation should be expected to provide, to me at least, is high quality medical care, particularly for service-related injuries and illnesses. Unfortunately, besides the usual problems of inadequate resources devoted to veteran care, other forces are conspiring to undermine the quality of care provided to our veterans.

I don't know what it is or why it is, but of late the military seems to have become especially susceptible to the siren call of quackery. Well-meaning but scientifically—shall we say?—lacking advocates have been promoting the "integration" of pseudoscience in military medicine. In particular, thanks to the advocacy of a man named Col. (Dr.) Richard Niemtzow, battlefield acupuncture—I kid you not—has been introduced into military medicine. Several years ago, the Air Force even deployed acupuncturists to Iraq, and there was interest from Army Rangers in adopting "battlefield acupuncture" techniques in the field. More recently, "energy medicine" has found a home in the military with reiki use having been described as being at Camp Pendleton (yes, to treat returning Marines for post-traumatic stress disorder). Marines could also receive something called Chakra Spread and Chakra Connection. Yes, it's every bit as ridiculous as it sounds.

Not content to have found a foothold in medical medicine, quackery is now attempting to invade the Veterans Administration (VA).

I don't know how I missed this story, which dates back to September 16. Perhaps it was because the press releases announcing it came out when I had just returned from London and was frantically preparing for a conference I was helping to organize last Friday. (Nothing like returning from an overseas trip and having to dive right into a considerably busier than usual work schedule, thanks to the proximity of a meeting.) Be that as it may, thanks to Steve Novella and Harriet Hall, I'm aware now: The largest "professional" organization for the quacks known as naturopaths, the American Association of Naturopathic Physicians (AANP, which unfortunately shares an abbreviation with the American Association of Nurse Practitioners and must be distinguished from such a respectable organization) has teamed up with American Veterans (AMVETS) to lobby Congress to pass a bill that would pay for "natural, non-pharmacological approaches to treating veterans suffering from chronic pain":

AMVETS, one of the nation’s largest veterans service organizations, has joined with the American Association of Naturopathic Physicians (AANP) in seeking to promote natural, non-pharmacological approaches to treating veterans suffering from chronic pain.

The organizations have collaborated via a “Dear Colleague” letter in the US House of Representatives calling on the Department of Veterans Affairs (VA) to take steps to employ licensed naturopathic physicians, who are specially trained in natural, non-invasive methods of healing. A “Dear Colleague” letter to that effect has begun circulating in the US House of Representatives. Leading the charge is Congressman Mark Pocan (D-WI), who – like many of his colleagues – is concerned about the dangers of overmedicating veterans, especially with painkilling opioids. Rep. Pocan is joined by Representatives Julia Brownley (D-CA), Suzan DelBene (D-WA), Earl Blumenauer (D-OR), Raul Grijalva (D-AZ), and Walter Jones as the letter’s initial signators.

“After incidents across the country of veterans overdosing on or abusing opioids associated with chronic pain, it is clear we need a new approach to veterans’ pain management,” Rep. Pocan stated. “Our veterans deserve access to all possible forms of care when making their healthcare decisions, including the services provided by naturopathic doctors (NDs).”

So let's see. Rep. Pocan's argument, fed to him no doubt by the AANP and facilitated by AMVETS, seems to boil down to this: Opiate pain relievers, as effective as they are, have a downside, including dependence, addiction, and overdosing. Because of these problems, a common problem with opioids is that physicians are often overly cautious prescribing opioids, resulting in undertreatment of chronic pain. What "non-pharmacologic" treatments of chronic pain would help? Neither the AMVETS press release nor Rep. Pocan's "Dear Colleague" letter says.

How would our veterans be provided access to naturopathic care? AMVETS, the AANP, and Rep. Pocan urge VA Secretary Robert McDonald to assign an employment code to licensed NDs so that they can be brought into the agency’s healthcare system. Right now, apparently, NDs (or, as I like to refer to them, "not a doctor") cannot be on staff at VA hospitals and VA facilities right now, which is good. There is no employment code for them.

But why? Why should the VA change its policy and allow NDs to be on staff at VA facilities in order to offer naturopathic modalities to our veterans. The AMVET press release trots out the usual misinformation and naturopathy talking points:

For military veterans, chronic pain often coexists with other health problems such as posttraumatic stress disorder (PTSD), depression, anxiety, and sleep disturbances. NDs are well suited to help, since they are specially trained in natural, non-pharmacological approaches that facilitate the body’s self-healing ability.

Approximately 4,400 NDs are licensed to practice naturopathic medicine, having earned their degree from 4-year postgraduate naturopathic medical schools accredited through the US Department of Education. The approaches studied include nutritional counseling and stress reduction, botanical medicine, therapeutic manipulation, and oriental medicine. A strong emphasis is placed on disease prevention and educating patients on proactive self-care to maintain wellness. Resolutions passed by the US Senate have urged Americans to learn more about this “safe, effective, and affordable form of health care.”

Ugh. No. As has been described by "naturopathic apostate" Britt Hermes, naturopathic education is nowhere near the equivalent of the education conventional physicians receive in medical school and their clinical residencies and fellowships. Naturopathic research is rife with unethical practices, and the accreditation of naturopathic education is a sham.

I know I've said it more times than I can remember, but naturopathy is quackery. It just is. If you don't believe me, let me remind you that an integral part of naturopathic training is The One Quackery To Rule Them All, homeopathy. As I've described many times, homeopathy is not only a required part of the naturopathic curriculum, but the naturopathic certification examination, the NPLEX, tests new graduates of naturopathy school on homeopathy. You can't have naturopathy without homeopathy. You just can't. Naturopaths will retort that not all naturopaths use homeopathy, but so what? They all learn it. Naturopathy as a profession embraces homeopathy. If naturopaths are employed by the VA, you can bet your bottom dollar that they will be prescribing homeopathic remedies to our veterans, which to me is even worse than the parody of battlefield acupuncture that I wrote years ago.

Naturally (word choice intentional), one of the arguments used in the press release and open letter is an appeal to popularity. The AANP commissioned a nationwide survey of America's veterans and reports that "nearly two-thirds of veterans (64%) would prefer a doctor who prescribes natural therapies before considering drugs or surgery, and that nearly three-quarters of veterans (73%) would consider seeing a ND if he or she were on staff at a nearby VA facility." You can bet that the respondents to this survey basically had little or no idea what these "natural therapies" are or what naturopaths are and do. Most Americans don't, which is why naturopaths have been so successful in hoodwinking credulous state legislatures into licensing their profession. For instance, if respondents knew what these natural therapies were and how nonexistent the scientific evidence is to support most of them, I doubt the numbers would be so high.

If homeopathy were the only quackery embraced by naturopathy, that would be bad enough, but it isn't. For instance, as Harriet Hall points out, a naturopathic textbook describes the four humors at great length, while recommending that hydrogen peroxide baths be used to treat asthma, with gems worn as jewelry placed around the home. It recommends herbs and chelation therapy for heart disease and hypertension. For HIV/AIDS, the AIDS Research Center at Bastyr recommends “acupuncture detoxification auricular program,” cranioelectrical stimulation, and colloidal silver.

Other pseudoscience routinely recommended by naturopaths includes:

• Treatment of the acute stroke patient for at least 20 minutes with an "ice-cold compress ... over the carotid arteries under the jaw bone on the neck" (which "may even abort the stroke") and subtle energy medicine.[25] The author of these recommendations is listed as a "senior editor of the Journal of Naturopathic Medicine, the official publication of the American Association of Naturopathic Physicians."
• The early detection of multiple sclerosis by "pulse" and "tongue" diagnosis, such as to effect a cure by hydrotherapy, homeopathy, acupuncture, diet, and other methods.[26] The author of these claims is Chief Medical Officer of the Southwest College of Naturopathic Medicine.
• The prevention and cure of breast cancer by an assortment of nonstandard tests and "supplements."[27] The author of these claims "has lectured regularly at the Canadian College of Naturopathic Medicine on breast health and stress management."
• The treatment of cancer of the prostate with "electrical current in the form of positive galvanism, applied transrectally."[28] This recommendation is from "Articles written by Naturopathic Physicians for the general public" (on the AANP Web site). The author is Chief Medical Officer of the Southwest College of Naturopathic Medicine.
• Ubiquitous "toxin" claims, including antifluoridation statements, warnings against most proven pharmaceuticals, and the assertion that "25% of Americans suffer from heavy metal toxicity."[29]

You get the idea. Unfortunately, there's more, oh so much more. If naturopaths are allowed into the VA system, you can bet that lots of this quackery, and a lot more, will be offered to our veterans, and you and I, the taxpayers of the United States, will be paying for it.

This push to insinuate naturopaths into the VA medical system is the result of a clear plan concocted by the AANP, which at its spring legislative conference, "NDs and naturopathic medical students swarmed Capitol Hill expressing the need for the VA to bring NDs into its employment mix." Maybe it's just me and my nasty old skepticism, but somehow I doubt that this "swarming" of NDs and not-doctors to be was spontaneous.

However the AANP concocted this scheme, it's clear that AMVETS, which does good work representing vets, has made a grave mistake here in falling for the blandishments of the AANP and putting its good name behind a naked lobbying effort to insert naturopathic quackery (but I repeat myself) into the VA system. Our veterans, particularly those who fought for their country and paid a high price through being wounded in battle or suffering from PTSD after multiple deployments, deserve far better. Instead of embracing easy pseudoscience, what the VA really needs are the resources and the support to expand its science-based medical offerings and, quite simply, to improve access to effective pain and mental health services.